Health care experts say the prognosis is not good for
California creating a single-payer health care system this year, even as fears
grow over the impact of Republican federal lawmakers' plans to gut the
Affordable Care Act.

Gay state Senator Ricardo Lara (D-Bell Gardens) and lesbian state Senator Toni Atkins
(D-San Diego) last month introduced their
Californians for a Healthy California Act (Senate Bill 562), which is backed by
the California Nurses Association, to jumpstart the process of creating a
universal health care system that would cover all 39 million Californians,
including the estimated 3 million undocumented immigrants living in the state.

They have yet to release a more detailed plan for how the
state would achieve that goal but have pledged to do so in the "weeks
ahead."

"Access to affordable and quality health care is not
only critical, it should be a right for everyone in California," stated
Atkins. "In light of threats to the Affordable Care Act, it's important
that we look at all options to maintain and expand access to health care. The
Healthy California Act is an essential part of that conversation."

Added Lara, "We need to have this conversation now
while hundreds of thousands of people are speaking out in support of health
care. With Republicans on the brink of rolling back health care it's time for
California to lead. I look forward to bringing a bill that Californians can
support and the governor will sign."

Past attempts to do so have failed in California, such as
when voters rejected a statewide ballot initiative in 1994. And out former
lawmakers have seen opposition from insurance companies and other special
interests sink their past legislation.

Former Governor Arnold Schwarzenegger
twice vetoed bills carried by lesbian former state
Senator Sheila Kuehl, now a Los
Angeles county supervisor. And gay former state Senator Mark Leno
(D-San Francisco) saw his 2012 bill to establish a
single-payer health care system pass out of the Senate only to die in the
Assembly.

Speaking during a multiday program held earlier this month
for journalists taking part in the University of Southern California Annenberg Center
for Health Journalism's 2017 California Fellowship, several health care experts
from differing political backgrounds questioned if the latest proposal would
garner enough political support this year.

"I still don't put good chances on it passing. There
are a lot of big interests lined up against it," said Michael Lujan
, who helped establish Covered California, the
state's health insurance exchange begun under the ACA, as its director of
sales.

Lujan is now the chief sales officer of Limelight Health, a
Silicon Valley startup he co-founded. He noted other states that have tried to
create single-payer systems have encountered problems in doing so.

Colorado voters in November rejected a 10 percent payroll
tax that would have paid for a state-run universal health care program. Vermont
ended its single-payer system in 2014 three years after its implementation due
to ballooning costs for small businesses.

"People want it but don't want to pay for it,"
said Lujan.

Lanhee Chen, Ph.D.,
the David and Diane Steffy Research Fellow at the Hoover Institution at
Stanford University who advises Republicans on health care issues, outright
dismissed the idea of single-payer as being too costly.

"Show me a place where it has worked sustainably with
the added expenses," said Chen. "Vermont had to pull back because
they couldn't tax people enough to pay for it."

Should such a system be implemented in California, he
suggested he would relocate elsewhere.

"I am a big believer in the fact we have a federal
system of government that says states should experiment," said Chen,
though he added, "If voters in California decided to go with a
single-payer system, it makes it much less attractive for me to live in
California."

Peter Long, the
president and CEO of the Blue Shield of California Foundation, also expressed
doubts about "putting faith" into a single-payer system, as he said
it "doesn't solve all the underlying issues" involved in providing
people health care.

Nonetheless, Lujan said the debate over creating universal
health care in the Golden State should be had.

"I can't defend why we shouldn't have the discussion. We
have medical bankruptcy even post the ACA. Other countries don't," he
said, adding, "In the U.S. we are proud of some strange things, like a
medical system that doesn't work."

Noam Levey, a
reporter for the Los Angeles Times who covers health, said the state law's
chances for passage are likely tied to what happens with the efforts in
Washington, D.C. to replace the ACA, commonly known as Obamacare, with the House
GOP's American Health Care Act.

Through Covered California, 1.2 million Californians signed
up for health care on the state exchange, while an additional 3.7 million state
residents gained coverage through the expansion of Medi-Cal, the state's Medicaid
program. People in both groups are now at risk of losing their insurance under
the AHCA.

"If the Republican bill passes, if not single-payer
there will be serious discussion in California on if the state can maintain
what Obamacare did," said Levey.